The purpose of this study was to test the hypothesis that horses with proximal enteritis (PE) are predisposed to hepatic injury. We also determined whether the presence of liver injury in horses with PE was associated with other clinicopathologic abnormalities or affected outcome. The medical records of all horses admitted for evaluation of colic and gastric reflux between 1984 and 2002 were reviewed. Horses were considered to have PE if the diagnosis was made at surgery or postmortem examination or if they had clinical findings consistent with PE. Horses with a small intestinal strangulating obstruction (SISO) were used as the control group. Historic and clinicopathologic data were collected for each horse. The data were analyzed by descriptive statistics, parametric and nonparametric analyses, and logistic regression. Horses with PE had significantly higher serum gamma-glutamyltransferase (GGT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) activities than horses with SISO (P < .05). Horses with PE were 12.1 times more likely to have high GGT activities than were horses with SISO. Horses with PE had an increased risk of at least 1 hepatic enzyme being increased if a high anion gap or large volume of reflux was present. Our conclusion is that horses with PE are more likely to have hepatic injury than horses with SISO. The mechanism of hepatic injury may involve ascending infection from the common bile duct, absorption of endotoxin or inflammatory mediators from the portal circulation, or hepatic hypoxia resulting from systemic inflammation and endotoxemic shock.